The urologist told the patient that the mass on the imaging was consistent with malignancy and was a Bosniak scale 3. The urologist recommended a nephrectomy rather than a biopsy. The patient underwent a nephrectomy. Pathology revealed an infarct and benign reno-medullary interstitial kidney tumor. Subsequent to this discovery, the patient’s other kidney began to fail.
Question(s) For Expert Witness
What is your experience evaluating and/or treating patients with benign reno-medullary interstitial cell tumors?
Can these tumors cause flank pain? Please explain.
What imaging characteristics prompt the diagnosis of a benign reno-medullary interstitial cell tumor?
What is the role of biopsy versus nephrectomy in a case like this?
Expert Witness Response E-116275
I am a specialist in urologic oncology with extensive experience in the treatment and management of patients with kidney cancer and other tumors of the kidney. I have an established publication record on the details and nuances of kidney tumor surgery and optimal renal mass treatment. I am an associate professor of surgical oncology at a large cancer center in the Mid-Atlantic. I am also the director of our institution's urologic oncology fellowship. This is a rare type of tumor and is not expected in the routine differential for a renal mass/Bosniak scale 3 abnormality. The most common anticipated result would be renal cell carcinoma or a benign renal oncocytoma. It is not possible to comment on the likelihood of this tumor causing pain or symptoms without additional details about the renal mass, such as the size and location within the affected kidney. In general, most kidney abnormalities that are small in size are typically asymptomatic. Flank pain would not be expected to be associated with a tumor unless it was very large and causing significant changes to the normal kidney. There would be no predictive imaging findings to distinguish this type of tumor from renal cancer. If there is a question as to whether a renal mass is a renal cell carcinoma, a biopsy can be applied prior to nephrectomy. It is not, however, a standard of care step that is mandatory prior to surgical treatment. What may be a separate question is whether or not the nephrectomy was the indicated procedure, or if an alternative surgery could have been offered.
About the author
Wendy Ketner, M.D.
Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.
Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.
Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.
